[unreadable] Specific Aims: Trauma center hospitals play a critical role in responding to disasters. To date, this role has largely proceeded on an ad hoc basis with little attention to preparing multiple trauma centers to work together in a network should an overwhelming disaster occur. The result has been a less than optimal "trauma systems" response in dealing with disasters. Based on this deficit, we specifically aim to answer the following questions for the 25 most highly urbanized cities in the US: [unreadable] [unreadable] (1) DISASTER PREPAREDNESS AIM - How well-covered are each of the 25 largest cities in terms of their medical abilities to respond to injury-generating disasters? At what quantity of severely injured casualties in each city will surrounding local, regional, and statewide trauma centers be overwhelmed thereby necessitating the execution of mutual aid agreements? [unreadable] [unreadable] (2) DISASTER RESPONSE AIM - What is the mathematically optimal order of execution for mutual aid agreements from neighboring trauma centers so that severely injured casualties in each of the top 25 cities will receive trauma care in the shortest period of time? As mutual aid agreements from neighboring trauma centers are executed to address an emergent disaster, what are the negative health effects arising from the sudden inability of these trauma centers to fully address their own day-to-day injuries? [unreadable] [unreadable] (3) DATA EVALUATION AIM - How can 15 different national databases be best used to improve their contribution to disaster management by the trauma care system? How might these disparate databases be coordinated across jurisdictional boundaries and among system owners to provide quantitative decision support for trauma systems faced with disasters? Research Design and Methods: The proposed project is an exploration to improve the trauma systems response to disasters. In order to accomplish this, it will make use of an innovative mathematical model that incorporates geographic information systems technology and specialized linear and integer programming. Using these methods will efficiently answer the questions put forward as part of the proposed specific aims and fill gaps in knowledge brought on by the near absence of informatics research conducted to support the decision-making of trauma system managers faced with disasters. [unreadable] [unreadable] Long-Term Objectives: The proposed project's results will ultimately be of value to many US cities as they plan their medical responses to injury-generating disasters. Important trade-offs and response strategies for policymakers interested in improving trauma care systems preparedness for disasters will be explored. [unreadable] [unreadable] [unreadable] [unreadable] [unreadable] [unreadable]